Breast Milk, Formula, or Both?

Parenting Resources and Community Outreach

Breastfeeding is recommended by experts, including the American Academy of Pediatrics, for the first year of life. Because of its nutritional composition, breast milk is the ideal food for babies. Research shows that it will also help protect your baby from infections.

Although it seems like it should be easy, breastfeeding is a skill that both baby and mom have to learn. Don’t be upset if breastfeeding doesn’t go smoothly at first. Almost everyone goes through a period of adjustment. If you have any difficulties, call your pediatrician’s office for advice or assistance.

On the other hand, don’t feel guilty if you decide to bottle-feed your baby. Infant formula is a good nutritional alternative to breast milk. And remember, there are benefits for your baby to get even small amounts of breast milk, so providing expressed breast milk along with formula is okay too. Your pediatrician can help you choose a formula for your baby.

Breastfeeding

Most newborns sleep a good deal of the time in the first days after birth and are content with the small amount of breast milk, called colostrum, that is available during this period. Colostrum contains substances that help strengthen your baby’s immune system and protect her from infections.

Most new mothers feel their milk come in three days after birth, although it can take as long as eight days in some women. After your lactation begins, the breasts are naturally ready to produce milk. Breastfeeding your baby or expressing your milk with hand-expression or a pump early and often will help ensure an abundant supply.

Wash your hands before each feeding to help prevent the spread of germs.

To begin the feeding process, hold your baby in a comfortable “tummy-to-tummy” position near your breast, with his head and neck in a straight line. Stroke his cheek in the direction you want him to turn, and when he opens his mouth, bring him to the nipple quickly, with as wide open a mouth as possible. His lips should be flanged outward and he should be taking in as much of the areolar region as possible — not just nipple.

“Latching on” is the term used to describe how the baby takes the nipple and the dark area around the nipple into his mouth for breastfeeding. Although all healthy babies instinctively know how to suck, not all babies know how to latch on properly. This may take some time. If you feel pain when your baby latches on, or if you feel pain throughout the feeding, your baby may not have latched on properly. Refer to the steps described above. If you’re still having problems, call your pediatrician’s office for advice.

Your baby’s sucking will stimulate your body to make and release milk. This is called the let-down reflex. As you and your baby get used to the routine of nursing, you’ll begin to recognize this feeling.

Your body will make milk according to your baby’s needs. The more you breastfeed, the more milk your body will make. If you breastfeed less often, your body will make less milk.

Because breast milk is more easily and completely digested than formula, breast-fed babies need to eat more often than bottle-fed babies. Many newborns need to nurse every two or three hours. As they get older, they will be able to go longer between feedings.

Your baby lets you know when he’s hungry by crying, nuzzling against your breast and making sucking motions. Use these signals – not the clock – to decide when to nurse. Let him make his own schedule.

Start each feeding on one breast and allow the baby to finish before offering the other breast. Your baby is ready to change breasts when he falls asleep or stops sucking. Although both breasts should be offered during a feeding, do not be alarmed if your baby will take only one breast. If your baby seems sleepy after the first breast, you may want to wake him by changing his diaper or playing with him a little before switching him to the second side.

Many new mothers worry whether their baby is getting enough to eat when they breastfeed. If your baby is having more than five wet diapers per day, several small stools per day, is happy between feedings and is gaining weight, you can be assured that he is receiving enough breast milk. On the other hand, a newborn who wants to nurse continuously and never seems satisfied may not be getting enough to eat. Do not hesitate to call the pediatrician’s office if you have any questions or concerns.

Also, don’t be alarmed if your baby suddenly wants to eat more often. She is probably just going through a growth spurt. This is common at 3 weeks, 6 weeks, 3 months and 6 months of age. Your milk supply will adjust in a day or two, and your baby should go back to a regular feeding pattern.

It is important to care for yourself while breastfeeding. Nursing mothers should try to eat well, drink plenty of fluids, get plenty of rest and continue to take prenatal vitamins. Some, but not all, medications can be taken safely while breastfeeding. If you need to take any medication, including over-the-counter medication, please check with your pediatrician to make sure it is safe. Avoid alcohol and caffeine while breastfeeding.

Keep your breasts clean for your baby by bathing daily with warm water. (Avoid soap on your breasts.) Excessive washing may dry the skin too much and make breastfeeding uncomfortable. If this happens, apply a small amount of expressed breast milk or ultra-purified lanolin to the breast and nipple area and allow it to air dry. Allow your nipples to air dry after each feeding. Wear a good supportive nursing bra, but avoid underwires.

Formula Feeding

There are several good formulas available for feeding your baby, all of which can provide the nourishment needed for normal growth and development. Formulas containing iron are best for the first year of life. Your pediatrician will guide you in selecting formula for your baby.

Formulas are available in ready-to-feed, concentrated and powdered forms. In general, the powdered form will be the most economical. The addition of the prescribed amount of fluoridated water, according to the directions, will provide the correct amount of fluoride needed by your baby. There is no need to provide vitamins since these are already contained in the formula.

A flexible feeding schedule is best. Very young babies may want to be fed every two to three hours. Most infants will feed every three to four hours. Babies need not be fed every time they cry. Babies rarely sleep through the night during the first weeks of life and frequently awaken to be fed and changed. It is important not to allow your baby to go more than six hours between feedings during early infancy.

Once prepared, formula can be stored safely for up to 48 hours in the refrigerator; unused formula should be discarded. Formula should be given to your baby at room temperature – though either cold or slightly heated formula is acceptable. If you like, you may warm it slightly by setting the bottle down in warm tap water, but be sure to test the milk to ensure it is not too hot for the baby. Never use a microwave oven to warm the milk. Never prop the bottle or let your baby feed alone. Do not let your baby sleep with a bottle. This may cause “milk bottle caries” or bad cavities of the front teeth.

As a general rule, most babies will drink about 2 ounces of formula per pound of body weight per day (24 hours). Your baby, if bottle-fed, should be on a formula throughout the first year of life. Do not change your baby’s formula before consulting his pediatrician.

Bottle/Equipment Sterilization

Sterilize bottles when new. Further sterilization is not necessary. Wash bottles, nipples and caps in hot soapy water soon after use and then rinse thoroughly. If well water is used for washing bottles, it should be boiled a minimum of 5 minutes before using.